Side effects from cosmetic use generally result from unintended paralysis of facial muscles. These include partial facial paralysis, muscle weakness, and trouble swallowing. Side effects are not limited to direct paralysis however, and can also include headaches, flu-like symptoms, and allergic reactions.[27] Just as cosmetic treatments only last a number of months, paralysis side-effects can have the same durations.[citation needed] At least in some cases, these effects are reported to dissipate in the weeks after treatment.[citation needed] Bruising at the site of injection is not a side effect of the toxin but rather of the mode of administration, and is reported as preventable if the clinician applies pressure to the injection site; when it occurs, it is reported in specific cases to last 7–11 days.[citation needed] When injecting the masseter muscle of the jaw, loss of muscle function can result in a loss or reduction of power to chew solid foods.[27]
What Other Factors Determine the Cost of Botox? The fixed cost of Botox or Dysport that the doctor pays for the drugs is relatively expensive and therefore that cost is obviously passed along to the patient. The cost of Botox or Dysport injections also depends upon the number of areas that are required to obtain the best results. The more areas that need treatment the greater the amount of injections that will be required to arrive at the most desirable result. Simply put -the more areas that need  treatment the higher the cost of treatment.
I would caution against shopping around for cheap Botox. There are practitioners than offer bargain prices that are not sustainable from a business standpoint. They may be diluting their Botox or injecting less units than advertised.  Also, some practitioners charge less per unit of Botox but inject significantly more Botox than is required to achieve the optimal outcome. For instance, 60 units of Botox at $10/unit is more expensive than 45 well placed units at $12/unit. 
Other side effects of BOTOX® and BOTOX® Cosmetic include: dry mouth, discomfort or pain at injection site, tiredness, headache, neck pain, eye problems: double vision, blurred vision, decreased eyesight, drooping eyelids, swelling of eyelids, dry eyes, and drooping eyebrows. In people being treated for urinary incontinence other side effects include: urinary tract infection, painful urination, and/or inability to empty your bladder on your own. If you have difficulty fully emptying your bladder after receiving BOTOX®, you may need to use disposable self-catheters to empty your bladder up to a few times each day until your bladder is able to start emptying again.

Postmarketing reports indicate that the effects of BOTOX® Cosmetic and all botulinum toxin products may spread from the area of injection to produce symptoms consistent with botulinum toxin effects. These may include asthenia, generalized muscle weakness, diplopia, ptosis, dysphagia, dysphonia, dysarthria, urinary incontinence and breathing difficulties. These symptoms have been reported hours to weeks after injection. Swallowing and breathing difficulties can be life threatening and there have been reports of death. The risk of symptoms is probably greatest in children treated for spasticity but symptoms can also occur in adults treated for spasticity and other conditions, particularly in those patients who have an underlying condition that would predispose them to these symptoms. In unapproved uses, including spasticity in children, and in approved indications, cases of spread of effect have been reported at doses comparable to those used to treat cervical dystonia and spasticity and at lower doses.
Botox comes as a crystalline substance from the manufacturer, which then has to be reconstituted with saline or another liquid. Practitioners add varying amounts of liquid when reconstituting it. Although there is no right or wrong amount of liquid to add, most physicians add about 2 mL-3 mL (about a half a teaspoon) of liquid to each vial. Some add quite a bit more, which can lead patients to think they are getting more Botox when, in reality, they are getting the same or less amount of Botox than samples reconstituted in a stronger way. It is the total dose of medication, not the volume of liquid, that leads to the desired effect.
The potency Units of BOTOX® Cosmetic are specific to the preparation and assay method utilized. They are not interchangeable with other preparations of botulinum toxin products and, therefore, units of biological activity of BOTOX® Cosmetic cannot be compared to nor converted into units of any other botulinum toxin products assessed with any other specific assay method.

In 2010, Allergan pleaded guilty and agreed to pay $600 million to resolve allegations that it unlawfully promoted Botox for conditions--including headaches, pain, spasticity and juvenile cerebral palsy--that at the time were not approved by the FDA. In one of the complaints, prosecutors said that Allergan "illegally, vigorously and without any thought to the possible negative health effects to which it subjected patients, promoted off-label uses of Botox." The U.S. Department of Justice also argued that Allergan exploited on-label uses for cervical dystonia--a disorder characterized by extreme neck-muscle contractions--to "grow off-label pain and headache sales." Prosecutors also argued that Allergan paid doctors to give presentations and trainings to other physicians about Botox uses that at the time were off-label.
Botox only lasts three to six months—and yet what's less commonly discussed is this: Facial muscles naturally weaken over time and going overboard in a certain area could have unwanted consequences. "If you do too much Botox on your forehead for many, many years, the muscles will get weaker and flatter," cautions Wexler, adding that the skin can also appear thinner and looser. Moreover, as your muscles become weaker, they can start to recruit surrounding muscles when you make facial expressions. "If one stops using their forehead muscles, they may start squinting using their nose and have wrinkles along the side of their nose," she explains. Translation: You need even more Botox for the newly recruited muscles, says Wexler. To avoid these kind of missteps, researching a doctor diligently is essential, as is approaching injectables conservatively, and asking questions about how the treatment will be tailored to your needs.
Still, there have been enough concerns that the FDA instituted a REMS (Risk Evaluation and Mitigation Strategy) requirement for all botulinum toxin preparations that specifically addresses the issues of distant spread of the toxin and the risk of problems, leading to death, from swallowing or breathing issues in certain patients who may be susceptible after botulinum toxin treatment. All products, including Dysport, Myobloc, Xeomin, and Botox, are monitored via this strategy. This is specifically aimed at a certain population of patients receiving more than the usual doses of botulinum toxin and not aimed at the casual user of Botox, per se.
Temporary bruising is the most common side effect of Botox. Headaches, which resolve in 24-48 hours, can occur, but this is rare. A small percentage of patients may develop eyelid drooping. This usually resolves in three weeks. This usually happens when the Botox moves around so you shouldn't rub the treated area for 12 hours after injection or lay down for three to four hours.
Other treatment areas that have been proven to be useful include the scalp (for migraine headaches), neck, facial and peripheral muscles (for spasms), arm pits (to inhibit sweating), the bladder and numerous other areas. The way that Botox and Dysport work is that they temporarily inhibit muscle contraction beneath the skin. When underlying muscles are relaxed the overlying folds and wrinkles are smoothed out. These injections work only by weakening underlying muscle contraction are not facial fillers like Restylane or Juvederm. Fillers and Botox or Dysport injections are not interchangeable. These injections work only by weakening underlying muscle contraction are not facial fillers like Restylane or Juvederm. Fillers are not interchangeable with Botox or Dysport injections. Fillers replace or “fill-in” lost facial volume whereas Botox or Dysport only inhibit muscle contraction.Both treatments are in fact complimentary aesthetic injections that will relax wrinkles and folds and help you regain your youthful appearance and enhance your face.
In clinical trials, 6.5% of patients (36/552) initiated clean intermittent catheterization for urinary retention following treatment with BOTOX® 100 Units as compared to 0.4% of patients (2/542) treated with placebo. The median duration of catheterization for patients treated with BOTOX® 100 Units was 63 days (minimum 1 day to maximum 214 days) as compared to a median duration 11 days (minimum 3 days to maximum 18 days) for patients receiving placebo.
The company markets brand products in six therapeutic areas: aesthetics/dermatology/plastic surgery; neurosciences/CNS; eye care; women’s health and urology; GI and cystic fibrosis; and cardiovascular disease and infectious disease. The company's products include Botox (botulinum toxin), Namenda (memantine), Restasis (ciclosporin), Linzess (linaclotide), Bystolic (nebivolol), Juvederm (injectable filler), Latisse (bimatoprost), Lo Loestrin Fe, Estrace (estradiol), Teflaro (ceftaroline fosamil), Dalvance (dalbavancin, Ozurdex (dexamethasone), Optive, Natrelle, Viibryd (vilazodone), Liletta (levonorgestrel), Saphris (asenapine), Enablex (darifenacin), Actonel (risedronic acid), Androderm (testosterone), and Gelnique (oxybutynin).[1]
Many times, effects on spasticity are longer lasting. It is not clear if this is due to breaking down patterned movements (many muscles contracting together rather than singly) or from allowing weak muscles to get stronger over time (that were overpowered before by more spastic muscles pulling against them). It is vital to have close follow-up after the injections to figure out the best course of treatment.
The potency Units of BOTOX® Cosmetic are specific to the preparation and assay method utilized. They are not interchangeable with other preparations of botulinum toxin products and, therefore, units of biological activity of BOTOX® Cosmetic cannot be compared to nor converted into units of any other botulinum toxin products assessed with any other specific assay method.
So when I first propositioned my husband about the idea of me getting a bit of Botox for the furrowed brow I've earned from a decade of writing and editing behind a computer screen, he was adamantly against it. And frankly, I was a bit scared too. I mean, isn't Botox poison? As an idealistic 21 year old, it was easy to say that I'd never put that stuff in my body, that "poison." Now, I'm not so sure.
Even if Botox's mechanism isn't always well understood and some of its off-label uses are still unproven, interest in the drug isn't likely to wane. "Botox is a big cash cow for the physicians' practices," says Ronny Gal, an investment analyst at Sanford C. Bernstein who has watched the drug closely for more than a decade. "When I talk to physicians, they say, 'Botox is not a problem. It works and gives you the result you want.' If it works for depression and atrial fibrillation, it could be massive."
In general, adverse reactions occur within the first week follo wing injection of BOTOX and while generally transient, may have a duration of several months or longer. Localized pain, infection, inflammation, tenderness, swelling, erythema, and/or bleeding/bruising may be associated with the injection. Needle-related pain and/or anxiety may result in vasovagal responses (including e.g., syncope, hypotension), which may require appropriate medical therapy.
Chronic migraines are what were formerly known as “transformed” migraines. These are near daily headaches, sometimes with migraine features but otherwise with frequent features of tension headaches. This may sound trivial but the treatment for tension headaches, typically with analgesics, would only make this syndrome worse. We learned that treating these with migraine preventive medications proved mostly effective. The current International Classification of Headache Disorders defines chronic migraine as a recurrent headache that has been ongoing for the past 3 months, occurs on at least 15 days per month, lasts at least 4 hours per day, and has 8 or more days per month when the headache has features of a migraine or responds to a typical migraine medication.
In the event of overdose, antitoxin raised against botulinum toxin is available from the Centers for Disease Control and Preventio n (CDC) in Atlanta, GA. However, the antitoxin will not reverse any botulinum toxin-induced effects already apparent by the time of antitoxin administration. In the event of suspected or actual cases of botulinum toxin poisoning, please contact your local o r state Health Department to process a request for antitoxin through the CDC. If you do not receive a response within 30 minutes, please contact the CDC directly at 1-770-488-7100. More information can be obtained at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5232a8.htm.
The efficacy of BOTOX for the treatment of upper limb spasticity was evaluated in three randomized, multi-center, double-blind, placebo-controlled studies (Studies 1, 2, and 3). Two additional randomized, multi-center, double-blind, placebo-controlled studies for upper limb spasticity in adults also included the evaluation of the efficacy of BOTOX for the treatment of thumb spasticity (Studies 4 and 5).

The migraines started later in life, before my lupus diagnosis. While sometimes they’d come out of the blue or I’d wake up with them, other times I’d see them coming. From a neurologist’s suggestion, I learned some of my “triggers” such as weather changes (specifically, drops in barometric pressure and incoming storms), hormonal changes and dairy. This past year I significantly reduced my dairy intake and although that didn’t eliminate the migraines, if I did eat dairy, I was sure to get one. Many of my migraines would also start as tension headaches. My neck is always extremely tight and eventually the constant tightness causes a migraine. Due to this, my old rheumatologist suggested taking a muscle relaxer at the beginning of a headache or before bed to keep my muscles from tensing up overnight and preventing a migraine. It worked sometimes… but definitely not enough.
Don’t be a pill. You're more likely to get a bruise at the site of the needle injection if you're taking aspirin or ibuprofen; these medications thin the blood and increase bleeding which causes the bruise. Skip the pills for two weeks in advance of your treatment. You should also tell your doctor -- before treatment -- about any supplements you're taking, even if they're "natural," because some (such as fish oil pills, gingko, or vitamin E) also thin blood. Your doctor may ask you not to use those supplements for two weeks before your treatment.

The potency Units of BOTOX® are specific to the preparation and assay method utilized. They are not interchangeable with other preparations of botulinum toxin products and, therefore, Units of biological activity of BOTOX® cannot be compared to nor converted into Units of any other botulinum toxin products assessed with any other specific assay method.


Currently, to participate in ARMR, you must be a patient at one of the study’s enrolling medical centers. You can see a full list of the participating centers here. “The number of centers participating in the ARMR is growing rapidly,” Dr. Schwedt says. “There will be eight or nine centers by the end of this year, and ARMR will continue to grow in 2019.” Patients at any of the participating centers who are interested in ARMR can visit ARMR.org to learn more and can contact their clinician’s office to find out how to enroll. Once enrolled, participants answer online questionnaires, provide a blood sample, and maintain a daily headache diary. Visit the ARMR website for more information and to learn about how you can get involved in the study.
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Deaths as a complication of severe dysphagia have been reported after treatment with botulinum toxin. Dysphagia may persist f or several months, and require use of a feeding tube to maintain adequate nutrition and hydration. Aspiration may result from severe dysphagia and is a particular risk when treating patients in whom swallowing or respiratory function is already compromised.
During a recent therapy session, one of Dr. Norman Rosenthal's regulars said he was considering suicide. It wasn't the first time the patient had entertained the thought, and even though he was on antidepressants and always kept up with his appointments, Rosenthal, a licensed psychiatrist with a private practice in North Bethesda, Md., wanted to offer his patient something else.
CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.
As part of the settlement, Allergan agreed to plead guilty to one criminal misdemeanor misbranding charge and pay $375 million. The company acknowledged that its marketing of Botox led to off-label uses of the drug. Allergan also agreed to pay $225 million to resolve civil charges alleging that the marketing of Botox had caused doctors to file false reimbursement claims, though Allergan denied wrongdoing. The company said in a statement that the settlement was in the best interest of its stockholders because it avoided litigation costs and "permits us to focus our time and resources on ... developing new treatments."
A randomized, multi-center, double-blind, placebo-controlled study of the treatment of cervical dystonia was conducted. This study enrolled adult patients with cervical dystonia and a history of having received BOTOX in an open label manner with perceived good response and tolerable side effects. Patients were excluded if they had previously received surgical or other denervation tre atment for their symptoms or had a known history of neuromuscular disorder. Subjects participated in an open label enrichment period where they received their previously employed dose of BOTOX. Only patients who were again perceived as showing a response were advanced to the randomized evaluation period. The muscles in which the blinded study agent injections we re to be administered were determined on an individual patient basis.
BOTOX® treats the symptoms of severe underarm sweating when topical medicines do not work well enough in people 18 years and older. It is not known whether BOTOX® is safe or effective for severe sweating anywhere other than your armpits. BOTOX® treatments temporarily block the chemical signals from the nerves that stimulate the sweat glands, resulting in reduced sweating.
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